I just had my 4th baby (great delivery in the water, no tearing) 16 days ago and today saw my midwife who confirmed I have severe cystocele (the most severe case she has seen) and general pelvic floor problems. In addition my pelvic bone separated during labor. I am going to start exercises and PT at 6 weeks but am feeling pretty upset right now. Has anyone had this/know of good treatment options/etc... my husband is wondering if we should see an obgyn for their opinion...I am just sad.

Big hugs... I'm sorry you've joined the pelvic organ prolapse "club" (and isn't "POP" just way too cheery a term for the condition?)

There's a huge, and I do mean HUGE, thread here at mdc about POP. You can read through it here..

POP is generally considered a "quality of life" condition so treatment options (both holistic and allopathic) are going to vary based on how you, personally, are feeling and what you individually find "ok". There are a LOT of things you can do right now (and congrats on the new babe!):

--- Use gravity to your advantage and try to keep your pelvis "up"... feet up is good, but getting your bladder and other organs back into place with gravity is better. Prop your bum up on pillows in bed, avoid standing for long periods of time, rock on hands and knees or in a chest to floor/child's pose with your hips up, anything to encourage those organs back into place. Especially right now. Being just a few weeks after the birth a lot can change and you want to make this period of time count!

--- when sitting, avoid those donut pillows and use a memory foam style pillow if you need extra comfort. The foam will provide support (unlike the donut) without too much pressure.

--- acupressure on your own or acupuncture from a pro is another option. Spleen 6 and Kidney 3 are good general prolapse points, Stomach 36 can help you stay regular which can reduce symptoms and Urinary Bladder 60 is good for preventing UTIs (which are more common with bladder prolapse).

--- Mayan Womb masssage may help with POP in general (not just uterine prolapse). Mothering Magazine had an article (March-April 2010) on the massage in relation to fertility, and gave a DIY guide in the article. Search the mothering homepage for "mayan womb massage" and I'm sure you'll find the link if this one doesn't work (scroll down, it's right above Peggy's Kitchen).

--- Check out POP support forums like The Whole Woman, exercise routines like the Tupler Technique (the BAKS basics are free online, there are mdc threads about the technique, and you can start more or less as soon as the babe is out... her Mummy Tummy book has great ideas for pelvic floor healing too), and books like Beyond Kegels (a life saver in my bladder prolapsed world) and Ending Female Pain.

--- stay hydrated and regular by whatever means necessary. Void often and as fully as possible (void, stand up, then void again while leaning forward and pressing against the pubic bone or lifting the lower stomach area can help get more out of a saggy bladder). Aloe vera juice or prune juice can help with regularity, though I've often resorted to a short course of miralax or other over the counter laxative to make sure I avoid constipation right after birth.

And over all... just hang in there! There are schools of medical thought that wont even diagnose a "permanent" prolapse until a year postpartum, and symptoms that will resolve gradually once pregnancy hormones (and then breastfeeding hormones) are no longer playing such a large role. Prolapse is becoming one of the more commonly reported conditions in younger women, but the medical world still sees it as an end-of-life condition and some of the attitudes out there can be pretty scary. Attitudes and treatments are changing, and options are opening up all the time. It's really normal to feel let down or "broken" (I've been living with POP for 4 years now and still have bad days). Just be gentle with yourself, enjoy your baby, and remember it's going to be ok!

(((hugs)))

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I recommend checking out Katy Bowman's workshops. It has helped me a lot. Her stuff is available through www.katysays.com. Her blog is worth reading if nothing else--it's full of tips for pelvic floor problems.

Wife to DH from Mexico, and mother to DD (01/10); DS (09/11); and one on the way (03 or 04/14)

First of all THANK YOU so much for writing and taking the time to share so much information. I knew something wasn't quite right and when my midwife told me what was going on on top of the pelvic separation I just felt so saddened. It was nice to know I am not alone and also to get some feedback as she just told me to order a book, start exercising and that we would start PT after my 6 week appt....

When you have a moment I have a couple questions. For the remedies you suggested, can you give me more info or point me where to look. I think I have read about red rasberry leaf tea for after pregnancy but have no idea what to do with the rest of the info. Are they also teas? tintures?

How much do I "need" to stay off my feet? Since I have three kids 3--8 that I homeschool (plus the new baby) I am wondering is it important I get help for the next few weeks so that I can actually lie down a bit during the day? Is sitting just as bad as standing? my husband was home this week so I was able to be off my feet lots but I am having a hard time imagining how to do this when he returns tomorrow and don't want to cause things to be worse...

this is a bit of of TMI question, but I don't see where anyone has mentioned it. I have some "bits" that hang out of/into my vaginal opening and they are dry, red, irritated and painful (which makes sense to me since they don't belong there...) Is there anything to do to/put on the area so that it does not hurt so much or get so irritated?

and I guess I am just confused about the whole thing in that I don't understand if the chances are things will improve or I need to find a way to get used to this awful, painful feeling...Obviously its pretty upsetting and I really appreciate you taking the time to give me so much help.

Red Raspberry Leaf... there are a lot of options. I generally drink Traditional Medicinal Red Raspberry Leaf tea since it's available at most grocery stores and not that expensive (I've been drinking RRL since I was a teen dealing with really bad menstrual cramps), but there are other teas and tinctures out there. Mountain Meadow Herbs makes a nice tincture blend if you don't like the tea, and I believe Earth Mama Angel Baby cramp tea is also mostly RRL. The idea is that RRL works to "tone" the uterus and that's a good thing for most women in general, but great for prolapsed women in particular.

For the homeopathics, I think I was taking arnica and pulsatilla 200c every 15-20 minutes at first, then 3 or 4 times a day, then as needed. If you know a homeopath you might see if a different dosage would be better for you (since dosage/schedule is highly individual) but that general dosage/guideline should be ok.

Bach Flower Remedies... they're available at my local Wegmans grocery store, but they're also available at various health food stores and Whole Foods. They're aimed at specific conditions, so you might check their website to see if there's a specific remedy that calls out to you.

Chapping/dryness- I found that sitz baths (often with the red raspberry tea and some salt) helped, especially if I followed up the sitz bath with some aloe vera gel. It was messy, but did soothe the tissue and reduce swelling. Staying hydrated and regular also helps me keep stuff "in where it belongs".

Staying off your feet- well, POP is a quality of life issue. So if you are up and about and find your POP feels worse, then that's "too much" for you. During the first year of my POP I kept a tiny daily journal (I forget the company, but it was a page and a half with little boxes for each day of the year, designed to record menstrual info and stuff like that). I kept track of how well I slept, how active I was, and how "lapsie" I felt at the end of the day. This helped me figure out my own limits but also helped emotionally as I was able to see that, over time, my symptomatic days really were becoming fewer and further between even though it didn't really "feel" that way. The goal during the early days is to have gravity pull your organs back "up and in" while your body is still doing it's big time healing form birth (your uterus is moving anyway and you want it to move as much as possible so that other organs can shift back into place too!)... so standing/sitting/walking all those things that involve gravity pulling "down and out" on already weakened tissue can be a problem. But I know how hard it is to add young children to the mix! Can you try things like nursing your newest while side lying on the couch with your other kiddos in the room? Or playing on the floor (you in a chest down/bum up position) with them? Or sitting in a recliner set waaaaaay back so gravity will be your friend? Every bit helps so don't worry if you can't spend a week in bed with your hips up! Just do what you can.

Options- once you're past the first few months and your hormones/body have stabilized a bit you can try things like a pessary (or a sea sponge) to hold everything up/in a bit more (this can help with the chaffing and dryness too). There are hormonal creams you can use on vaginal tissue (once breastfeeding is established if that's a concern). Kegels and similar exercises can work wonders if done properly, and you'll find the exercise routine that is both manageble for your schedule and works best at reducing symptoms. The general medical statement is that "prolapse wont get better without surgical intervention" but there are LOTS of women who really have found that they can reduce their symptoms with time, effort, and behavioral changes. I'm nowhere near as symptomatic now as I was in the first year, or even the second year. But if I overdo it, I know about it, and there are things I can't do anymore. For example, I can't use my diva cup at all, I've been warned I might have trouble with a IUD (should I ever go that route), a long day on my feet chasing kiddos means a "lapsie" night and chaffing the next day, I need to stay on top of my hydration/elimination to the point of near obsession or the impact on my prolapse is "not good", I may eventually need surgery (once I'm past the whole childbearing/breastfeeding years) if my symptoms worsen with age (not uncommon, but not a sure thing either).

I wish there was more clear cut info for you (and me both! lol) but POP really is a frustrating and understudied condition. It's only moved closer to the spotlight in the past few years and there are still a lot of care providers who either see POP as "inevitable" for women who have had children, or "inevitable" for women as they age, or as "just" an end of life issue that can be dealt with using surgery and depends, or "just" a surgical opportunity waiting to happen. It can take time/effort to find a care provider who is up on the literature, open to non-surgical treatments, and still willing to take your symptoms and quality of life seriously.

Hang in there and good luck with the PT! It can make a big difference. :)

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Just wanted to chime in and say how much I'm appreciating this info., too. I had cystocele/rectocele issues after my second birth, and it contributed mightily to the depression I suffered then. Everything I read was so dire. I am a distance runner and thought I could never run again. I thought sex would hurt forever. I thought surgery would be the only help and then there would be the terrible side-effects of surgery. After time, kegels, losing weight, getting more core/pelvic tone back, and eventually less frequent breastfeeding, things got SO MUCH BETTER. Of course, I'm 1 week post partum now and right back to feeling bad. I just keep trying to remember how much things improved over time the last time--of course, I'm scared this is progressive and will be worse/more permanent this time than the last time.

Does it always get worse with each successive pregnancy?

Also, anyone know if there's a relationship between those tummy tightening belts and worsening the prolapse? I always have bad muscle separation, and this time I thought I would try one of those tummy squeezing belt things to speed that side of recovery along, but it seemed to make the prolapse worse--like it smooshed everything downward. Of course, I also started wearing it around the time I started getting up and walking around more, so it could be coincidental. ??

Yes, those tummy tighening belts can make prolapse worse. Basically, think of your abdominal cavity like a balloon. You squeeze one part and another part pops out. I found that I couldn't carry my (very fat) baby girl in a sling because of my prolapse, for the same reason. It required too much abdominal support and even the hip belt for my ergo squished things out too much. It did get better over time. I will say, now 3 years past the birth that caused the injury for me, that things are generally good. I do lots of core/abdominal/kegels work daily, and I did have about 4 months of pelvic floor physical therapy. Upon the advice of my PT, I did see a urogyn and was fitted with a pessary. I actually didn't end up using the pessary on any regular basis, but I'm glad that I have it. This year I decided to train for a marathon and I found that when I run longer than about 5-6 miles, I can feel things "falling out" again. My solution: I wear the pessary for long runs, and it works like a charm.

In any case, the basic principle is that you don't want to do anything that causes downward pressure on your abdomen. Rather than wearing a belt, do the exercises that are described in either the "Lose your Mummy Tummy" book or "Exercise After Pregnancy" book. Both are very good. When you do kegels, make sure you're ONLY activating that one muscle. And when you're doing anything for abdominal/core work, STOP if you feel any pressure on your pelvic floor. Ideally, you want to activate your pelvic floor first, and THEN do your core stuff. Worry more about doing the exercise correctly, and less about how many or how hard you do it. That will come with time.

Thank you so much! I have stopped the tummy belt the past few days & already feel better. Will dig out my Mummy Tummy book (we moved a few weeks ago so--bec. of the baby--many things are still in boxes...).

Good point about the Ergo. I wore DD2 in the Ergo all the time, and I'm sure that made things worse for me last time around. I'm gonna have to just find alternatives whenever possible with DS.